document_title: Infant mortality

question_text: the leading cause of infant death in the us is

question_tokens: the leading cause of infant death in the us is

text: Infant mortality

text: Classification[edit]

text: Infant mortality rate (IMR) is the number of deaths per 1,000 live births of children under one year of age. The rate for a given region is the number of children dying under one year of age, divided by the number of live births during the year, multiplied by 1,000.[10]

text: Forms of infant mortality:

text:
Perinatal mortality is late fetal death (22 weeks gestation to birth), or death of a newborn up to one week postpartum.[10]
Neonatal mortality is newborn death occurring within 28 days postpartum. Neonatal death is often attributed to inadequate access to basic medical care, during pregnancy and after delivery. This accounts for 40–60% of infant mortality in developing countries.[11]
Postneonatal mortality is the death of children aged 29 days to one year. The major contributors to postneonatal death are malnutrition, infectious disease, troubled pregnancy, Sudden Infant Death Syndrome and problems with the home environment.[12]

text: Causes[edit]

text: Causes of infant mortality directly lead to the death.[13] Environmental and social barriers prevent access to basic medical resources and thus contribute to an increasing infant mortality rate; 99% of infant deaths occur in developing countries, and 86% of these deaths are due to infections, premature births, complications during delivery, and perinatal asphyxia and birth injuries.[10] Greatest percentage reduction of infant mortality occurs in countries that already have low rates of infant mortality.[14] Common causes are preventable with low-cost measures. In the United States, a primary determinant of infant mortality risk is infant birth weight with lower birth weights increasing the risk of infant mortality. The determinants of low birth weight include socio-economic, psychological, behavioral and environmental factors.[15]

text: Medical[edit]

text: Causes of infant mortality that are related to medical conditions include: low birth weight, sudden infant death syndrome, malnutrition and infectious diseases, including neglected tropical diseases.

text: Low birth weight[edit]

text: Low birth weight makes up 60–80% of the infant mortality rate in developing countries. The New England Journal of Medicine stated that "The lowest mortality rates occur among infants weighing 3,000 to 3,500 g (6.6 to 7.7 lb). For infants born weighing 2,500 g (5.5 lb) or less, the mortality rate rapidly increases with decreasing weight, and most of the infants weighing 1,000 g (2.2 lb) or less die. As compared with normal-birth-weight infants, those with low weight at birth are almost 40 times more likely to die in the neonatal period; for infants with very low weight at birth the relative risk of neonatal death is almost 200 times greater." Infant mortality due to low birth weight is usually a direct cause stemming from other medical complications such as preterm birth, poor maternal nutritional status, lack of prenatal care, maternal sickness during pregnancy, and an unhygienic home environments.[10] Along with birth weight, period of gestation makes up the two most important predictors of an infant's chances of survival and their overall health.[16]

text: According to the New England Journal of Medicine, "in the past two decades, the infant mortality rate (deaths under one year of age per thousand live births) in the United States has declined sharply." Low birth weights from African American mothers remain twice as high as that of white women. LBW may be the leading cause of infant deaths, and it is greatly preventable. Although it is preventable, the solutions may not be the easiest but effective programs to help prevent LBW are a combination of health care, education, environment, mental modification and public policy, influencing a culture supporting lifestyle.[17] Preterm birth is the leading cause of newborn deaths worldwide.[18] Even though America excels past many other countries in the care and saving of premature infants, the percentage of American woman who deliver prematurely is comparable to those in developing countries. Reasons for this include teenage pregnancy, increase in pregnant mothers over the age of thirty-five, increase in the use of in-vitro fertilization which increases the risk of multiple births, obesity and diabetes. Also, women who do not have access to health care are less likely to visit a doctor, therefore increasing their risk of delivering prematurely.[19]

text: Sudden infant death syndrome[edit]

text: Thousands of infant deaths per year are classified as sudden infant death syndrome (SIDS). According to the Mayo Clinic, SIDS is the unexplained death, usually during sleep, of a seemingly healthy baby. Although the direct cause of SIDS remains unknown, many doctors believe that there are several factors that put babies at an increased risk of SIDS, including: babies sleeping on their stomachs, exposure to cigarette smoke in the womb or after birth, sleeping in bed with parents, premature birth, being a twin or triplet, being born to a teen mother, and also living in poverty settings. Although the cause is unknown and currently cannot be explained, doctors have come to the conclusion that SIDS is most likely to occur between 2 and 4 months and most deaths occur in the winter time. Recommended precautions include ensuring that infants sleep on their backs, controlling the temperature of the bedroom, employing a crib without toys or excess bedding, and breastfeeding.[20]

text: Malnutrition[edit]

text: Malnutrition frequently accompanies these[which?] diseases, and is a primary factor contributing to the complications of both diarrhea and pneumonia, although the causal links and mechanisms remain unclear. Factors other nutrition also influence the incidence of diarrhea, including socioeconomic status, disruption of traditional lifestyles, access to clean water and sanitation facilities, age and breastfeeding status.

text: Protein energy malnutrition and micronutrient deficiency are two reasons for stunted growth in children under five years old in the least developed countries. Malnutrition leads to diarrhea and dehydration, and ultimately death. Millions of women in developing countries are stunted due to a history of childhood malnutrition. Women's bodies are thus underdeveloped, and their chances of surviving childbirth decrease. Due to underdeveloped bodies, the probability of an obstructed pregnancy increases. Protein-energy deficiency results in low-quality breastmilk that provides less energy and other nutrition.[10]

text: Vitamin A deficiency can lead to stunted growth, blindness, and increased mortality due to the lack of nutrients in the body. Two hundred and fifty million infants are affected by Vitamin A deficiency. Among women in developing countries, 40% have iron deficiency anemia, which increases maternal and infant mortality rates, chances of stillbirth, cases of low birth weight babies, premature delivery, and probability of fetal brain damage.[10] One way to prevent Vitamin A deficiency is to educate the mother on the many benefits of breastfeeding. Breastmilk is a natural source of Vitamin A, and supplies the suckling infant with enough Vitamin A.[21]

text: Infectious diseases[edit]

text: Babies born in low to middle income countries in sub-Saharan Africa and southern Asia are at the highest risk of neonatal death. Bacterial infections of the bloodstream, lungs, and the brain's covering (meningitis) are responsible for 25% of neonatal deaths. Newborns can acquire infections during birth from bacteria that are present in their mother's reproductive tract. The mother may not be aware of the infection, or she may have an untreated pelvic inflammatory disease or sexually transmitted disease. These bacteria can move up the vaginal canal into the amniotic sac surrounding the baby. Maternal blood-borne infection is another route of bacterial infection from mother to baby. Neonatal infection is also more likely with the premature rupture of the membranes (PROM) of the amniotic sac.[22]

text: Seven out of ten childhood deaths are due to infectious diseases: acute respiratory infection, diarrhea, measles, and malaria. Acute respiratory infection such as pneumonia, bronchitis, and bronchiolitis account for 30% of childhood deaths; 95% of pneumonia cases occur in the developing world. Diarrhea is the second-largest cause of childhood mortality in the world, while malaria causes 11% of childhood deaths. Measles is the fifth-largest cause of childhood mortality.[10][23] Folic acid for mothers is one way to combat iron deficiency. A few public health measures used to lower levels of iron deficiency anemia include iodize salt or drinking water, and include vitamin A and multivitamin supplements into a mother's diet.[10] A deficiency of this vitamin causes certain types of anemia (low red blood cell count).[24]

text: Environmental[edit]

text: Infant mortality rate can be a measure of a nation's health and social condition.[16][25] It is a composite of a number of component rates which have their separate relationship with various social factors and can often be seen as an indicator to measure the level of socioeconomic disparity within a country.[25]

text: Organic water pollution is a better indicator of infant mortality than health expenditures per capita. Water contaminated with various pathogens houses a host of parasitic and microbial infections. Infectious disease and parasites are carried via water pollution from animal wastes.[26] Areas of low socioeconomic status are more prone to inadequate plumbing infrastructure, and poorly maintained facilities.[10] The burning of inefficient fuels doubles the rate of children under 5 years old with acute respiratory tract infections.[10] Climate and geography often play a role in sanitation conditions. For example, the inaccessibility of clean water exacerbates poor sanitation conditions.[26]

text: People who live in areas where particulate matter (PM) air pollution is higher tend to have more health problems across the board. Short-term and long-term effects of ambient air pollution are associated with an increased mortality rate, including infant mortality. Air pollution is consistently associated with post neonatal mortality due to respiratory effects and sudden infant death syndrome. Specifically, air pollution is highly associated with SIDs in the United States during the post-neonatal stage.[27] High infant mortality is exacerbated because newborns are a vulnerable subgroup that is affected by air pollution.[28] Newborns who were born into these environments are no exception. Women who are exposed to greater air pollution on a daily basis who are pregnant should be closely watched by their doctors, as well as after the baby is born. Babies who live in areas with less air pollution have a greater chance of living until their first birthday. As expected, babies who live in environments with more air pollution are at greater risk for infant mortality. Areas that have higher air pollution also have a greater chance of having a higher population density, higher crime rates and lower income levels, all of which can lead to higher infant mortality rates.[29]

text: The key pollutant for infant mortality rates is carbon monoxide. Carbon monoxide is a colorless, odorless gas that does great harm especially to infants because of their immature respiratory system.[30] Another major pollutant is second-hand smoke, which is a pollutant that can have detrimental effects on a fetus. According to the American Journal of Public Health, "in 2006, more than 42 000 Americans died of second hand smoke-attributable diseases, including more than 41 000 adults and nearly 900 infants ... fully 36% of the infants who died of low birth weight caused by exposure to maternal smoking in utero were Blacks, as were 28% of those dying of respiratory distress syndrome, 25% dying of other respiratory conditions, and 24% dying of sudden infant death syndrome." The American Journal of Epidemiology also stated that "Compared with nonsmoking women having their first birth, women who smoked less than one pack of cigarettes per day had a 25% greater risk of mortality, and those who smoked one or more packs per day had a 56% greater risk. Among women having their second or higher birth, smokers experienced 30% greater mortality than nonsmokers."

text: Modern research in the United States on racial disparities in infant mortality suggests a link between the institutionalized racism that pervades the environment and high rates of African American infant mortality. In synthesis of this research, it has been observed that "African American infant mortality remains elevated due to the social arrangements that exist between groups and the lifelong experiences responding to the resultant power dynamics of these arrangements."[15]

text: It is important to note that infant mortality rates do not decline among African Americans even if their socio-economic status does improve. Parker Dominguez at the University of Southern California has made some headway in determining the reasoning behind this, claiming black women are more prone to psychological stress than other women of different races in the United States. Stress is a lead factor in inducing labor in pregnant women, and therefore high levels of stress during pregnancy could lead to premature births that have the potential to be fatal for the infant.[31]

text: Socio-economic factors[edit]

text: Social class is a major factor in infant mortality, both historically and today. Between 1912 and 1915, the Children's Bureau in the United States examined data across eight cities and nearly 23,000 live births. They discovered that lower incomes tend to correlate with higher infant mortality. In cases where the father had no income, the rate of infant mortality was 357% more than that for the highest income earners ($1,250+). Differences between races were also apparent. African-American mothers experience infant mortality at a rate 44% higher than average;[32] however, research indicates that socio-economic factors do not totally account for the racial disparities in infant mortality.[15]

text: While infant mortality is normally negatively correlated with GDP, there may indeed be some opposing short-term effects from a recession. A recent study by The Economist showed that economic slowdowns reduce the amount of air pollution, which results in a lower infant mortality rate. In the late 1970s and early 1980s, the recession's impact on air quality is estimated to have saved around 1,300 US babies.[33] It is only during deep recessions that infant mortality increases. According to Norbert Schady and Marc-François Smitz, recessions when GDP per capita drops by 15% or more increase infant mortality.[34]

text: Social class dictates which medical services are available to an individual. Disparities due to socioeconomic factors have been exacerbated by advances in medical technology. Developed countries, most notably the United States, have seen a divergence between those living in poverty who cannot afford medical advanced resources, leading to an increased chance of infant mortality, and others.[25]

text: War[edit]

text: In policy, there is a lag time between realization of a problem's possible solution and actual implementation of policy solutions.[clarification needed][35] Infant mortality rates correlate with war, political unrest, and government corruption.[10]

text: In most cases, war-affected areas will experience a significant increase in infant mortality rates. Having a war taking place where a woman is planning on having a baby is not only stressful on the mother and foetus, but also has several detrimental effects.

text: However, many other significant factors influence infant mortality rates in war-torn areas. Health care systems in developing countries in the midst of war often collapse. Attaining basic medical supplies and care becomes increasingly difficult. During the Yugoslav Wars in the 1990s Bosnia experienced a 60% decrease in child immunizations. Preventable diseases can quickly become epidemic given the medical conditions during war.[36]

text: Many developing countries rely on foreign aid for basic nutrition. Transport of aid becomes significantly more difficult in times of war. In most situations the average weight of a population will drop substantially.[37] Expecting mothers are affected even more by lack of access to food and water. During the Yugoslav Wars in Bosnia the number of premature babies born increased and the average birth weight decreased.[36]

text: There have been several instances in recent years of systematic rape as a weapon of war. Women who become pregnant as a result of war rape face even more significant challenges in bearing a healthy child. Studies suggest that women who experience sexual violence before or during pregnancy are more likely to experience infant death in their children.[38][39][40] Causes of infant mortality in abused women range from physical side effects of the initial trauma to psychological effects that lead to poor adjustment to society. Many women who became pregnant by rape in Bosnia were isolated from their hometowns making life after childbirth exponentially more difficult.[41]

text: Medicine and biology[edit]

text: Developing countries have a lack of access to affordable and professional health care resources, and skilled personnel during deliveries.[10][35] Countries with histories of extreme poverty also have a pattern of epidemics, endemic infectious diseases, and low levels of access to maternal and child healthcare.[42]

text: The American Academy of Pediatrics recommends that infants need multiple doses of vaccines such as diphtheria-tetanus-acellular pertussis vaccine, Haemophilus influenzae type b (Hib) vaccine, Hepatitis B (HepB) vaccine, inactivated polio vaccine (IPV), and pneumococcal vaccine (PCV). Research was conducted by the Institute of Medicine's Immunization Safety Review Committee concluded that there is no relationship between these vaccines and risk of SIDS in infants. This tells us that not only is it extremely necessary for every child to get these vaccines to prevent serious diseases, but there is no reason to believe that if your child does receive an immunization that it will have any effect on their risk of SIDS.[43]

text: Economics[edit]

text: Political modernization perspective, the neo-classical economic theory that scarce goods are most effectively distributed to the market, say that the level of political democracy influences the rate of infant mortality. Developing nations with democratic governments tend to be more responsive to public opinion, social movements, and special interest groups for issues like infant mortality. In contrast, non-democratic governments are more interested in corporate issues and less so in health issues. Democratic status effects the dependency a nation has towards its economic state via export, investments from multinational corporations and international lending institutions.[42]

text: Levels of socioeconomic development and global integration are inversely related to a nation's infant mortality rate.[10][44] Dependency perspective occurs in a global capital system. A nation's internal impact is highly influenced by its position in the global economy and has adverse effects on the survival of children in developing countries.[26] Countries can experience disproportionate effects from its trade and stratification within the global system.[45] It aids in the global division of labor, distorting the domestic economy of developing nations. The dependency of developing nations can lead to a reduce rate of economic growth, increase income inequality inter- and intra-national, and adversely affects the wellbeing of a nation's population. A collective cooperation between economic countries plays a role in development policies in the poorer, peripheral, countries of the world.[42]

text: These economic factors present challenges to governments' public health policies.[26] If the nation's ability to raise its own revenues is compromised, governments will lose funding for its health service programs, including services that aim in decreasing infant mortality rates.[42] Peripheral countries face higher levels of vulnerability to the possible negative effects of globalization and trade in relation to key countries in the global market.[26]

text: Even with a strong economy and economic growth (measured by a country's gross national product), the advances of medical technologies may not be felt by everyone, lending itself to increasing social disparities.[25]

text: Cultural[edit]

text: High rates of infant mortality occur in developing countries where financial and material resources are scarce and there is a high tolerance to high number of infant deaths. There are circumstances where a number of developing countries to breed a culture where situations of infant mortality such as favoring male babies over female babies are the norm.[10] In developing countries such as Brazil, infant mortality rates are commonly not recorded due to failure to register for death certificates.[46] Failure to register is mainly due to the potential loss of time and money and other indirect costs to the family.[46] Even with resource opportunities such as the 1973 Public Registry Law 6015, which allowed free registration for low-income families, the requirements to qualify hold back individuals who are not contracted workers.[46]

text: Another cultural reason for infant mortality, such as what is happening in Ghana, is that "besides the obvious, like rutted roads, there are prejudices against wives or newborns leaving the house."[47] Because of this it is making it even more difficult for the women and newborns to get the treatment that is available to them and that is needed.

text: Cultural influences and lifestyle habits in the United States can account for some deaths in infants throughout the years. According to the Journal of the American Medical Association "the post neonatal mortality risk (28 to 364 days) was highest among continental Puerto Ricans" compared to babies of the non-Hispanic race. Examples of this include teenage pregnancy, obesity, diabetes and smoking. All are possible causes of premature births, which constitute the second highest cause of infant mortality.[19] Ethnic differences experienced in the United States are accompanied by higher prevalence of behavioral risk factors and sociodemographic challenges that each ethnic group faces.[16]

text: Gender favoritism[edit]

text: Historically, males have had higher infant mortality rates than females. The difference between male and female infant mortality rates have been dependent on environmental, social, and economic conditions. More specifically, males are biologically more vulnerable to infections and conditions associated with prematurity and development. Before 1970, the reasons for male infant mortality were due to infections, and chronic degenerative diseases. However, since 1970, certain cultures emphasizing males has led to a decrease in the infant mortality gap between males and females. Also, medical advances have resulted in a growing number of male infants surviving at higher rates than females due to the initial high infant mortality rate of males.[48]

text: Genetic components results in newborn females being biologically advantaged when it comes to surviving their first birthday. Males, biologically, have lower chances of surviving infancy in comparison to female babies. As infant mortality rates saw a decrease on a global scale, the gender most affected by infant mortality changed from males experiences a biological disadvantage, to females facing a societal disadvantage.[48] Some developing nations have social and cultural patterns that reflects adult discrimination to favor boys over girls for their future potential to contribute to the household production level. A country's ethnic composition, homogeneous versus heterogeneous, can explain social attitudes and practices. Heterogeneous level is a strong predictor in explaining infant mortality.[44]

text: Birth spacing[edit]

text: Birth spacing is the time between births. Births spaced at least three years apart from one another are associated with the lowest rate of mortality. The longer the interval between births, the lower the risk for having any birthing complications, and infant, childhood and maternal mortality.[11][49] Higher rates of pre-term births, and low birth weight are associated with birth to conception intervals of less than six months and abortion to pregnancy interval of less than six months. Shorter intervals between births increase the chances of chronic and general under-nutrition; 57% of women in 55 developing countries reported birth spaces shorter than three years; 26% report birth spacing of less than two years. Only 20% of post-partum women report wanting another birth within two years; however, only 40% are taking necessary steps such as family planning to achieve the birth intervals they want.[11]

text: Unplanned pregnancies and birth intervals of less than twenty-four months are known to correlate with low birth weights and delivery complications. Also, women who are already small in stature tend to deliver smaller than average babies, perpetuating a cycle of being underweight.[10][11][49]

text: Education[edit]

text: The mother's educational attainment and literacy are correlated with age of first pregnancy, and probability that the mother attain prenatal and postnatal care. Mothers with a secondary education have a higher probability of waiting until a later age to get pregnant. Once pregnant, they are also more likely to get prenatal and postnatal care, and deliver their child in the presence of a skilled attendant. Women who finish at least a primary-level education have improved nutrition, medical care, information access, and economic independence. Infants reap benefits such as healthy environments, improved nutrition, and medical care. Mothers with some level of education have a higher probability to breastfeeding.[10][26][44] The duration of breastfeeding has the potential to influence the birth space.[49] Women without any educational background tend to have children at an earlier age, thus their bodies are not yet mature enough to carry and deliver a child.[10]

text: Prevention[edit]

text: Millennium Development Goals were created to improve the health and well being of people worldwide. Its fourth goal is to decrease the number of mortalities within the infant and childhood population by two thirds, a decrease from 95 to 31 deaths per 1000.[10] Countries slow to abide by the Millennium Development Goal by 2015 are projected to have difficulty in reaching goal four.[35]

text: Public health[edit]

text: Reductions in infant mortality are possible in any stage of a country's development.[14] Rate reductions are evidence that a country is advancing in human knowledge, social institutions and physical capital. Governments can reduce the mortality rates by addressing the combined need for education (such as universal primary education), nutrition, and access to basic maternal and infant health services. A policy focus has the potential to aid those most at risk for infant and childhood mortality allows rural, poor and migrant populations.[35]

text: Reducing chances of babies being born at low birth weights and contracting pneumonia can be accomplished by improving air quality. Improving hygiene can prevent infant mortality. Home-based technology to chlorinate, filter, and solar disinfection for organic water pollution could reduce cases of diarrhea in children by up to 48%.[10][23][26] Improvements in food supplies and sanitation has been shown to work in the United States' most vulnerable populations, one being African Americans. Overall, women's health status need to remain high.[25]

text: Simple behavioral changes, such as hand washing with soap, can significantly reduce the rate of infant mortality from respiratory and diarrheal diseases.[50] According to UNICEF, hand washing with soap before eating and after using the toilet can save more lives of children than any single vaccine or medical intervention, by cutting deaths from diarrhea and acute respiratory infections.[51]

text: Future problems for mothers and babies can be prevented. It is important that women of reproductive age adopt healthy behaviors in everyday life, such as taking folic acid, maintaining a healthy diet and weight, being physically active, avoiding tobacco use, and avoiding excessive alcohol and drug use. If women follow some of the above guidelines, later complications can be prevented to help decrease the infant mortality rates. Attending regular prenatal care check-ups will help improve the baby's chances of being delivered in safer conditions and surviving.

text: Focusing on preventing preterm and low birth weight deliveries throughout all populations can help to eliminate cases of infant mortality and decrease health care disparities within communities. In the United States, these two goals have decreased infant mortality rates on a regional population, it has yet to see further progress on a national level.[16]

text: Medical treatments[edit]

text: Technological advances in medicine would decrease the infant mortality rate and an increased access to such technologies could decrease racial and ethnic disparities. It has been shown that technological determinants are influenced by social determinants. Those who cannot afford to utilize advances in medicine tend to show higher rates of infant mortality. Technological advances has, in a way, contributed to the social disparities observed today. Providing equal access has the potential to decrease socioeconomic disparities in infant mortality.[25] Specifically, Cambodia is facing issues with a disease that is unfortunately killing infants. The symptoms only last 24 hours and the result is death. As stated if technological advances were increased in countries it would make it easier to find the solution to diseases such as this.[52] Recently, there have been declines in the United States that could be attributed to advances in technology. Advancements in the Neonatal Intensive Care Unit can be related to the decline in infant mortality in addition to the advancement of surfactants.[53] However, the importance of the advancement of technology remains unclear as the number of high-risk births increases in the United States.[53]

text: Cultural changes[edit]

text: Educated females practice a healthier lifestyle. The more educated a woman is the more likely she is to seek out care, give birth in the presence of a skilled attendant, breastfeed, and understand the consequences of HIV/AIDS.[10] Improving women's health and social status is one way to ameliorate infant mortality.[11] Status should rise for females seeking out education.[44] Providing women access to family planning centers can educate mothers on how to plan ahead for their families. Educational means can also teach mothers on the beneficial health practices such as breastfeeding. Government recognizing birth space as a possible health intervention is now working towards making affordable contraception available.[49]

text: Policies[edit]

text: Granting women employment raises their status and autonomy. Having a gainful employment can raise the perceived worth of females. This can lead to an increase in the number of women getting an education and a decrease in the number of female infanticide.[44] In the social modernization perspective, education leads to development. Higher number of skilled workers means more earning and further economic growth. According to the economic modernization perspective, this is one type economic growth viewed as the driving force behind the increase in development and standard of living in a country. This is further explained by the modernization theory- economic development promotes physical wellbeing. As economy rises, so do technological advances and thus, medical advances in access to clean water, health care facilities, education, and diet. These changes may decrease infant mortality.[42][44]

text: Economically, governments could reduce infant mortality by building and strengthening capacity in human resources. Increasing human resources such as physicians, nurses, and other health professionals will increase the number of skilled attendants and the number of people able to give out immunized against diseases such as measles. Increasing the number of skilled professionals is negatively correlated with maternal, infant, and childhood mortality. Between 1960 and 2000, the infant mortality rate decreased by half as the number of physicians increased by four folds.[35] With the addition of one physician to every 1000 persons in a population, infant mortality will reduce by 30%.

text: In certain parts of the U.S., specific modern programs aim to reduce levels of infant mortality. An example of one such program is the 'Healthy Me, Healthy You' program based in Northeast Texas. It intends to identify factors that contribute to negative birth outcomes throughout a 37-county area.[54] An additional program that aims to reduce infant mortality is the "Best Babies Zone" (BBZ) based at the University of California, Berkeley. The BBZ uses the life course approach to address the structural causes of poor birth outcomes and toxic stress in three U.S. neighborhoods. By employing community-generated solutions, the Best Babies Zone's ultimate goal is to achieve health equity in communities that are disproportionately impacted by infant death.[55]

text: Differences in measurement[edit]

text: The infant mortality rate correlates very strongly with, and is among the best predictors of, state failure.[clarification needed][57] IMR is therefore also a useful indicator of a country's level of health or development, and is a component of the physical quality of life index.

text: However, the method of calculating IMR often varies widely between countries, and is based on how they define a live birth and how many premature infants are born in the country. Reporting of infant mortality rates can be inconsistent, and may be understated, depending on a nation's live birth criterion, vital registration system, and reporting practices.[58] The reported IMR provides one statistic which reflects the standard of living in each nation. Changes in the infant mortality rate reflect social and technical capacities[clarification needed] of a nation's population.[14] The World Health Organization (WHO) defines a live birth as any infant born demonstrating independent signs of life, including breathing, heartbeat, umbilical cord pulsation or definite movement of voluntary muscles.[59] This definition is used in Austria, for example.[60] The WHO definition is also used in Germany, but with one slight modification: muscle movement is not considered to be a sign of life.[61] Many countries, however, including certain European states (e.g. France) and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and increases their rates of perinatal mortality.[62] In the Czech Republic and Bulgaria, for instance, requirements for live birth are even higher.[63]

text: Although many countries have vital registration systems and certain reporting practices, there are many inaccuracies, particularly in undeveloped nations, in the statistics of the number of infants dying. Studies have shown that comparing three information sources (official registries, household surveys, and popular reporters) that the "popular death reporters" are the most accurate. Popular death reporters include midwives, gravediggers, coffin builders, priests, and others—essentially people who knew the most about the child's death. In developing nations, access to vital registries, and other government-run systems which record births and deaths, is difficult for poor families for several reasons. These struggles force stress on families[clarification needed], and make them take drastic measures[clarification needed] in unofficial death ceremonies for their deceased infants. As a result, government statistics will inaccurately reflect a nation's infant mortality rate. Popular death reporters have first-hand information, and provided this information can be collected and collated, can provide reliable data which provide a nation with accurate death counts and meaningful causes of deaths that can be measured/studied.[46]

text: UNICEF uses a statistical methodology to account for reporting differences among countries:

text: UNICEF compiles infant mortality country estimates derived from all sources and methods of estimation obtained either from standard reports, direct estimation from micro data sets, or from UNICEF's yearly exercise. In order to sort out differences between estimates produced from different sources, with different methods, UNICEF developed, in coordination with WHO, the WB and UNSD, an estimation methodology that minimizes the errors embodied in each estimate and harmonize trends along time. Since the estimates are not necessarily the exact values used as input for the model, they are often not recognized as the official IMR estimates used at the country level. However, as mentioned before, these estimates minimize errors and maximize the consistency of trends along time.[64]

text: Another challenge to comparability is the practice of counting frail or premature infants who die before the normal due date as miscarriages (spontaneous abortions) or those who die during or immediately after childbirth as stillborn. Therefore, the quality of a country's documentation of perinatal mortality can matter greatly to the accuracy of its infant mortality statistics. This point is reinforced by the demographer Ansley Coale, who finds dubiously high ratios of reported stillbirths to infant deaths in Hong Kong and Japan in the first 24 hours after birth, a pattern that is consistent with the high recorded sex ratios at birth in those countries. It suggests not only that many female infants who die in the first 24 hours are misreported as stillbirths rather than infant deaths, but also that those countries do not follow WHO recommendations for the reporting of live births and infant deaths.[65]

text: Another seemingly paradoxical finding, is that when countries with poor medical services introduce new medical centers and services, instead of declining, the reported IMRs often increase for a time. This is mainly because improvement in access to medical care is often accompanied by improvement in the registration of births and deaths. Deaths that might have occurred in a remote or rural area, and not been reported to the government, might now be reported by the new medical personnel or facilities. Thus, even if the new health services reduce the actual IMR, the reported IMR may increase.

text: Collecting the accurate statistics of infant mortality rate could be an issue in some rural communities in developing countries. In those communities, some other alternative methods for calculating infant mortality rate are emerged, for example, popular death reporting and household survey.[46] The country-to-country variation in child mortality rates is huge, and growing wider despite the progress. Among the world's roughly 200 nations, only Somalia showed no decrease in the under-5 mortality rate over the past two decades.The lowest rate in 2011 was in Singapore, which had 2.6 deaths of children under age 5 per 1,000 live births. The highest was in Sierra Leone, which had 185 child deaths per 1,000 births. The global rate is 51 deaths per 1,000 births. For the United States, the rate is eight per 1,000 births.[66]

text: Infant mortality rate (IMR) is not only a group of statistic but instead it is a reflection of the socioeconomic development and effectively represents the presence of medical services in the countries. IMR is an effective resource for the health department to make decision on medical resources reallocation. IMR also formulates the global health strategies and help evaluate the program success. The existence of IMR helps solve the inadequacies of the other vital statistic systems for global health as most of the vital statistic systems usually neglect the infant mortality statistic number from the poor. There are certain amounts of unrecorded infant deaths in the rural area as they do not have information about infant mortality rate statistic or do not have the concept about reporting early infant death.[46]

text: Europe and America[edit]

text: The exclusion of any high-risk infants from the denominator or numerator in reported IMRs can cause problems in making comparisons. Many countries, including the United States, Sweden and Germany, count an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but according to United States some other countries differ in these practices. All of the countries named adopted the WHO definitions in the late 1980s or early 1990s,[67] which are used throughout the European Union.[68] However, in 2009, the US CDC issued a report that stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries. It also outlined the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.[69][70][71] However, the differences in reporting are unlikely to be the primary explanation for the United States' relatively low international ranking. Rather, the report concluded that primary reason for the United States’ higher infant mortality rate when compared with Europe was the United States’ much higher percentage of preterm births.[72]

text: The US National Institute of Child Health and Human Development (NICHD) has made great strides in lowering US infant mortality rates.[74][not in citation given] Since the institute was created the US infant mortality rate has dropped 70%, in part[vague] due to their research.[citation needed]

text: Russia[edit]

text: Until the 1990s, Russia and the Soviet Union did not count, as a live birth or as an infant death, extremely premature infants (less than 1,000 g, less than 28 weeks gestational age, or less than 35 cm in length) that were born alive (breathed, had a heartbeat, or exhibited voluntary muscle movement) but failed to survive for at least seven days.[75] Although such extremely premature infants typically accounted for only about 0.5% of all live-born children, their exclusion from both the numerator and the denominator in the reported IMR led to an estimated 22%–25% lower reported IMR.[76] In some cases, too, perhaps because hospitals or regional health departments were held accountable for lowering the IMR in their catchment area, infant deaths that occurred in the 12th month were "transferred" statistically to the 13th month (i.e., the second year of life), and thus no longer classified as an infant death.[77][78]

text: Brazil[edit]

text: In certain rural developing areas, such as northeastern Brazil, infant births are often not recorded in the first place, resulting in the discrepancies between the infant mortality rate (IMR) and the actual amount of infant deaths. Access to vital registry systems for infant births and deaths is an extremely difficult and expensive task for poor parents living in rural areas. Government and bureaucracies tend to show an insensitivity to these parents and their recent suffering from a lost child, and produce broad disclaimers in the IMR reports that the information has not been properly reported, resulting in these discrepancies. Little has been done to address the underlying structural problems of the vital registry systems in respect to the lack of reporting from parents in rural areas, and in turn has created a gap between the official and popular meanings of child death.[46] It is also argued that the bureaucratic separation of vital death recording from cultural death rituals is to blame for the inaccuracy of the infant mortality rate (IMR). Vital death registries often fail to recognize the cultural implications and importance of infant deaths. It is not to be said that vital registry systems are not an accurate representation of a region's socio-economic situation, but this is only the case if these statistics are valid, which is unfortunately not always the circumstance. "Popular death reporters" is an alternative method for collecting and processing statistics on infant and child mortality. Many regions may benefit from "popular death reporters" who are culturally linked to infants may be able to provide more accurate statistics on the incidence of infant mortality.[46] According to ethnographic data, "popular death reporters" refers to people who had inside knowledge of anjinhos, including the grave-digger, gatekeeper, midwife, popular healers etc. —— all key participants in mortuary rituals.[46] By combining the methods of household surveys, vital registries, and asking "popular death reporters" this can increase the validity of child mortality rates, but there are many barriers that can reflect the validity of our statistics of infant mortality. One of these barriers are political economic decisions. Numbers are exaggerated when international funds are being doled out; and underestimated during reelection.[46]

text: The bureaucratic separation of vital death reporting and cultural death rituals stems in part due to structural violence.[79] Individuals living in rural areas of Brazil need to invest large capital for lodging and travel in order to report infant birth to a Brazilian Assistance League office. The negative financial aspects deters registration, as often individuals are of lower income and cannot afford such expenses.[46] Similar to the lack of birth reporting, families in rural Brazil face difficult choices based on already existing structural arrangements when choosing to report infant mortality. Financial constraints such as reliance on food supplementations may also lead to skewed infant mortality data.[46]

text: In developing countries such as Brazil the deaths of impoverished infants are regularly unrecorded into the countries vital registration system; this causes a skew statistically. Culturally validity and contextual soundness can be used to ground the meaning of mortality from a statistical standpoint. In northeast Brazil they have accomplished this standpoint while conducting an ethnographic study combined with an alternative method to survey infant mortality.[46] These types of techniques can develop quality ethnographic data that will ultimately lead to a better portrayal of the magnitude of infant mortality in the region. Political economic reasons have been seen to skew the infant mortality data in the past when governor Ceara devised his presidency campaign on reducing the infant mortality rate during his term in office. By using this new way of surveying, these instances can be minimized and removed, overall creating accurate and sound data.[46]

text: Epidemiology[edit]

text:
World historical and predicted infant mortality rates per 1,000 births (1950–2050)
UN, medium variant, 2008 rev.[80]

Years
Rate
Years
Rate

1950–1955
152
2000–2005
52

1955–1960
136
2005–2010
47

1960–1965
116
2010–2015
43

1965–1970
100
2015–2020
40

1970–1975
91
2020–2025
37

1975–1980
83
2025–2030
34

1980–1985
74
2030–2035
31

1985–1990
65
2035–2040
28

1990–1995
61
2040–2045
25

1995–2000
57
2045–2050
23

tag: table

text: For the world, and for both less developed countries (LDCs) and more developed countries (MDCs), IMR declined significantly between 1960 and 2001. According to the State of the World's Mothers report by Save the Children, the world IMR declined from 126 in 1960 to 57 in 2001.[81]

text: However, IMR was, and remains, higher in LDCs. In 2001, the IMR for LDCs (91) was about 10 times as large as it was for MDCs (8). On average, for LDCs, the IMR is 17 times as higher than that of MDCs. Also, while both LDCs and MDCs made significant reductions in infant mortality rates, reductions among less developed countries are, on average, much less than those among the more developed countries.[clarification needed]

text: A factor of about 67 separate countries with the highest and lowest reported infant mortality rates. The top and bottom five countries by this measure (taken from The World Factbook's 2012 estimates[82]) are shown below.

text:
Rank
Country
Infant mortality rate
(deaths/1,000 live births)

1
Afghanistan
121.63

2
Niger
109.98

3
Mali
109.08

4
Somalia
103.72

5
Central African Republic
97.17

218
Sweden
2.74

219
Singapore
2.65

220
Bermuda
2.47

221
Japan
2.21

222
Monaco
1.80

text: According to Guillot, Gerland, Pelletier and Saabneh "birth histories, however, are subject to a number of errors, including omission of deaths and age misreporting errors."[83]

text: United States[edit]

text: The infant mortality rate in the US decreased by 2.3% to a historic low of 582 infant deaths per 100,000 live births in 2014.[84]

text: Of the 27 most developed countries, the U.S. has the highest Infant Mortality Rate, despite spending much more on health care per capita[citation needed]. Significant racial and socio-economic differences in the United States affect the IMR, in contrast with other developed countries, which have more homogeneous populations. In particular, IMR varies greatly by race in the US. The average IMR for the whole country is therefore not a fair representation of the wide variations that exist between segments of the population. Many theories have been explored as to why these racial differences exist with socio economic factors usually coming out as a reasonable explanation. However, more studies have been conducted around this matter, and the largest advancement is around the idea of stress and how it affects pregnancy.[85]

text: In the 1850s, the infant mortality rate in the United States was estimated at 216.8 per 1,000 babies born for whites and 340.0 per 1,000 for African Americans, but rates have significantly declined in the West in modern times. This declining rate has been mainly due to modern improvements in basic health care, technology, and medical advances.[86] In the last century, the infant mortality rate has decreased by 93%.[16] Overall, the rates have decreased drastically from 20 deaths in 1970 to 6.9 deaths in 2003 (per every 1000 live births). In 2003, the leading causes of infant mortality in the United States were congenital anomalies, disorders related to immaturity, SIDS, and maternal complications. Babies born with low birth weight increased to 8.1% while cigarette smoking during pregnancy declined to 10.2%. This reflected the amount of low birth weights concluding that 12.4% of births from smokers were low birth weights compared with 7.7% of such births from non-smokers.[87] According to the New York Times, "the main reason for the high rate is preterm delivery, and there was a 10% increase in such births from 2000 to 2006." Between 2007 and 2011, however, the preterm birth rate has decreased every year. In 2011 there was a 11.73% rate of babies born before the 37th week of gestation, down from a high of 12.80% in 2006.[88]

text: Economic expenditures on labor and delivery and neonatal care are relatively high in the United States. A conventional birth averages 9,775 USD with a C-section costing 15,041 USD.[89] Preterm births in the US have been estimated to cost $51,600 per child, with a total yearly cost of $26.2 billion.[90] Despite this spending, several reports state that infant mortality rate in the United States is significantly higher than in other developed nations.[15][91][92] Estimates vary; the CIA's World Factbook ranks the US 55th internationally in 2014, with a rate of 6.17, while the UN figures from 2005-2010 place the US 34th.

text: Aforementioned differences in measurement could play a substantial role in the disparity between the US and other nations. A non-viable live birth in the US could be registered as a stillbirth in similarly developed nations like Japan, Sweden, Norway, Ireland, the Netherlands, and France – thereby reducing the infant death count.[93] Neonatal intensive care is also more likely to be applied in the US to marginally viable infants, although such interventions have been found to increase both costs and disability. A study following the implementation of the Born Alive Infant Protection Act of 2002 found universal resuscitation of infants born between 20–23 weeks increased the neonatal spending burden by $313.3 million while simultaneously decreasing quality-adjusted life years by 329.3.[94]

text: The vast majority of research conducted in the late twentieth and early twenty-first century indicates that African-American infants are more than twice as likely to die in their first year of life than white infants. Although following a decline from 13.63 to 11.46 deaths per 1000 live births from 2005 to 2010, non-Hispanic black mothers continued to report a rate 2.2 times as high as that for non-Hispanic white mothers.[95]

text: Contemporary research findings have demonstrated that nationwide racial disparities in infant mortality are linked to the experiential state of the mother and that these disparities cannot be totally accounted for by socio-economic, behavioral or genetic factors.[15] The Hispanic paradox, an effect observed in other health indicators, appears in the infant mortality rate, as well. Hispanic mothers see an IMR comparable to non-Hispanic white mothers, despite lower educational attainment and economic status. A study in North Carolina, for example, concluded that "white women who did not complete high school have a lower infant mortality rate than black college graduates."[96] According to Mustillo's CARDIA (Coronary Artery Risk Development in Young Adults) study, "self reported experiences of racial discrimination were associated with pre-term and low-birthweight deliveries, and such experiences may contribute to black-white disparities in prenatal outcomes."[97] Likewise, dozens of population-based studies indicate that "the subjective, or perceived experience of racial discrimination is strongly associated with an increased risk of infant death and with poor health prospects for future generations of African Americans."[15]

text: African American[edit]

text: While earlier parts of this article have addressed the racial differences in infant deaths, a closer look into the effects of racial differences within the country is necessary to view discrepancies. Non-Hispanic Black women lead all other racial groups in IMR with a rate of 11.3, while the Infant Mortality Rate among white women is 5.1.[98] Black women in the United States experience a shorter life expectancy than white women, so while a higher IMR amongst black women is not necessarily out of line, it is still rather disturbing.[99] While the popular argument leads to the idea that due to the trend of a lower socio-economic status had by black women there is in an increased likelihood of a child suffering. While this does correlate, the theory that it is the contributing factor falls apart when we look at Latino IMR in the United States. Latino people are almost just as likely to experience poverty as blacks in the U.S., however, the Infant Mortality Rate of Latinos is much closer to white women than it is to black women. The Poverty Rates of blacks and Latinos are 24.1% and 21.4% respectively. If there is a direct correlation, then the IMR of these two groups should be rather similar, however, blacks have an IMR double that of Latinos.[100] Also, as black women move out of poverty or never experienced it in the first place, their IMR is not much lower than their counterparts experiencing higher levels of poverty.

text: Some believe black women are predisposed to a higher IMR, meaning ancestrally speaking, all black women from African descent should experience an elevated rate. This theory is quickly disproven by looking at women of African descent who have immigrated to the United States. These women who come from a completely different social context are not prone to the incredibly high IMR experienced by American-born black women.[101]

text: Tyan Parker Dominguez at the University of Southern California offers a theory to explain the disproportionally high IMR among black women in the United States. She claims African American women experience stress at much higher rates than any other group in the country. Stress produces particular hormones that induce labor and contribute to other pregnancy problems. Considering early births are one of the leading causes of death of infants under the age of one, induced labor is a very legitimate factor. The idea of stress spans socio-economic status as Parker Dominguez claims stress for lower-class women comes from unstable family life and chronic worry over poverty. For black middle-class women, battling racism, real or perceived, can be an extreme stressor.[102]

text: Arline Geronimus, a professor at the University of Michigan School of Public Health calls the phenomenon "weathering." She claims constantly dealing with disadvantages and racial prejudice causes black women's birth outcomes to deteriorate with age. Therefore, younger black women may experience stress with pregnancy due to social and economic factors, but older women experience stress at a compounding rate and therefore have pregnancy complications aside from economic factors.[103]

text: Strides have been made, however, to combat this epidemic. In Los Angeles County, health officials have partnered with non-profits around the city to help black women after the delivery of their child. One non-profit in particular has made a large impact on many lives is Great Beginnings For Black Babies in Inglewood. The non-profit centers around helping women deal with stress by forming support networks, keeping an open dialogue around race and family life, and also finding these women a secure place in the workforce.[104]

text: History[edit]

text: This section needs expansion. You can help by adding to it. (October 2016)

text: The leading causes of infant mortality have changed over time. Unpasteurized milk was the leading cause of infant mortality late in the 19th century.[105] Pasteurization of milk cut infant mortality by around 3/4.[105]


document_title: Life of the Party (2018 film)

question_text: who played helen on life of the party

question_tokens: who played helen on life of the party

root

text: Life of the Party (2018 film)

text: Plot[edit]

text:
After dropping off their daughter Maddie (Molly Gordon) to her senior year at Decatur University in Atlanta, Dan tells Deanna (Melissa McCarthy) that he wants a divorce because he has fallen in love with another woman, a realtor Marcie (Julie Bowen), and he also wants to sell their house under his name. Heartbroken, Deanna visits her parents Mike (Stephen Root) and Sandy (Jacki Weaver) to tell them what happened, but Mike is frustrated because Dan made Deanna drop out of her college because she was pregnant, as well as his overbearing ways during their marriage.
Deanna goes to see Maddie in her dorm to tell the news about her divorce and her plans to study again at the university to earn a degree in Archaeology. Maddie initially has doubts about her plan but she ultimately accepts it. Maddie introduces Deanna to her friends - Amanda (Adria Arjona), neurotic Debbie (Jessie Ennis), and Helen (Gillian Jacobs). Deanna later meets her agoraphobic and chronically depressed roommate Leonor (Heidi Gardner).

tag: p

text: On the first day of school, she meets demeaning girls, Jennifer (Debby Ryan) and her friend Trina (Yani Simone), who mocks Deanna's age. Deanna later signed the divorce papers, with her best friend Christine, in front of Dan and Marcie. At night, Maddie and her friends take Deanna to the party, where she meets a boy named Jack (Luke Benward), who later falls in love with her and, the next day, they have sex inside the library. In another night, they attend an 80's-themed party where Deanna has a dance-off with Jennifer, resulting in earning the respect of her schoolmates. Deanna later has stage fright during her oral presentation and she faints.

text: While Deanna hanging out for the dinner with Christine, her husband, and their couple friends, Dan and Marcie unexpectedly show up, who declare that they are getting married. Jack turns out to be Marcie's son and knowing about Deanna sleeping with Jack, Marcie walks out in disgust. On the night of Dan and Marcie's wedding, Deanna and her friends get high from chocolate bark laced with weed, and they head to the reception, where they start wrecking the wedding hall. Dan, Marcie, and Maddie find them and Marcie tells Deanna she is cut off financially from Dan. Deanna is filled with shame, if only because of how Maddie saw her.

text: Deanna tries to make amends with Maddie, but she tells her that she is leaving college since she has no means of completing the rest of the year on her own. The girls then come up with a plan to throw a party to raise money to pay for Deanna's tuition. Since everyone is at Christina Aguilera concert, Helen posts the message on her Twitter, claiming Aguilera will be at the party after her show. Christine shows up with her husband, as do Mike and Sandy. Mike offers to give Deanna a 401K check to pay her tuition, but Deanna refuses to take it. The party is not a success until Aguilera (who ends up being Leonor’s cousin) arrives and she puts on a show with Deanna and the girls to an excited crowd.

text: Later on, Deanna is due to repeat her presentation in class. She is still nervous until Maddie, Helen, Amanda, Debbie, and all the sorority sisters show up to support her, and Deanna manages to give the presentation with ease. At the end of the year, Deanna and Maddie graduate together, with all their friends and family there to support them. Maddie encourages Deanna to throw her cap in the air. She does so, and it hits Dan in the face, knocking out an earring he was wearing while Marcie berates him for losing the expensive diamond stud.

text: Cast[edit]

text:
Melissa McCarthy as Deanna "Dee Rock" Miles (née Cook)
Molly Gordon as Maddie Miles, Dan and Deanna's daughter
Gillian Jacobs as Helen, a sorority sister who is older than the rest due to having been in a coma for eight years.
Maya Rudolph as Christine Davenport, Deanna's neurotic and heavy drinking best friend
Jessie Ennis as Debbie, a sorority sister with "issues"
Adria Arjona as Amanda, another sorority sister with "issues"
Matt Walsh as Daniel "Dan" Miles, Deanna's ex-husband, Maddie's father
Julie Bowen as Marcie Strong, a real estate agent, Deanna's nemesis and Dan's lover
Debby Ryan as Jennifer, a "mean girl" in Deanna's archaeology class
Stephen Root as Michael "Mike" Cook, Deanna's father and Maddie's grandfather
Jacki Weaver as Sandy Cook, Deanna's mother and Maddie's grandmother
Luke Benward as Jack Strong, a frat boy infatuated with Deanna
Jimmy O. Yang as Tyler, Maddie's boyfriend and Jack's friend
Chris Parnell as Wayne Truzack, Deanna's professor
Heidi Gardner as Leonor, Deanna's reclusive Goth roommate
Yani Smone as Trina, Jennifer's snarky sidekick
Damon Jones as Frank Davenport, Christine's husband
Ben Falcone as Dale, the Uber driver
Nat Faxon as Lance
Sarah Baker as Gildred
Karen Maruyama as Mediator
Steve Mallory as Bill
Courtney Patterson as Amy
Steve Falcone (Ben Falcone's real-life father) as Older Man #1 / Vince
Michael D. McCarthy (Melissa McCarthy's real-life father) as Older Man #2 / Dennis
Christina Aguilera as herself (cameo)

tag: ul

text: Production[edit]

text: Filming began in August 2016 in the metro Atlanta area. The sorority house used in the film is The Twelve Oaks Bed & Breakfast (www.thetwelveoaks.com) located in Covington, GA. The interior of the mansion was replicated in a warehouse in Decatur, GA for the interior scenes and the exterior scenes were filmed on location at the inn.[citation needed]

text: Release[edit]

text: Life of the Party was released on May 11, 2018.[5] The first official trailer for the film was released on February 5, 2018.[6]

text: Reception[edit]

text: Box office[edit]

text: Life of the Party grossed 52.9 million in the United States and Canada, and $12.8 million in other territories, for a worldwide total of $65.7 million.[3]

text: In the United States and Canada, Life of the Party was released alongside Breaking In, and was projected to gross $18–21 million from 3,656 theaters in its opening weekend.[7] It made $4.9 million on its first day, including $700,000 from Thursday night previews, down from the $985,000 McCarthy's The Boss grossed in March 2016, and similar to the $650,000 grossed by Snatched on the Thursday before the same weekend the previous year.[2] The film went on to debut to $17.9 million, and finished second behind Avengers: Infinity War ($62 million in its third week); 80% of its audience was over the age of 25, while 70% was female.[8] It fell 57% in its second weekend, to $7.6 million, finishing fourth at the box office,[9] and another 33% to $5.1 million in its third, finishing fifth.[10]

text: Critical response[edit]

text: On review aggregation website Rotten Tomatoes, the film has an approval rating of 38% based on 129 reviews, and an average rating of 5/10. The site's critical consensus reads, "Life of the Party's good-natured humor and abundance of onscreen talent aren't enough to make up for jumbled direction and a script that misses far more often than it hits."[11] On Metacritic, the film has a weighted average score of 46 out of 100, based on reviews from 32 critics, indicating "mixed or average reviews."[12] Audiences polled by CinemaScore gave the film an average grade of "B" on an A+ to F scale, higher than the "C+" earned by McCarthy and Falcone's previous two film collaborations.[8]

text: Matt Zoller-Seitz of RogerEbert.com gave the film two out of four stars, calling it "the latest Melissa McCarthy star vehicle that fails to do justice to the sheer awesomeness of its leading lady."[13] Leigh Monson from Birth.MoviesDeath wrote, "One hundred minutes of self-indulgence and tedium, even if it's well-meaning in its intentions."[14]

text: Accolades[edit]

text:
Award

Category

Recipient

Result

Teen Choice Awards

Choice Summer Movie

Nominated

Choice Summer Movie Actress

Melissa McCarthy

Nominated

People's Choice Awards

The Comedy Movie Star of 2018

Pending


document_title: Legal drinking age

question_text: what is the age limit for alcohol in spain

text: Legal drinking age

text: Africa[edit]

text:
Country/region
De jure
Notes

Drinking Age
Purchase age

 Algeria
18[2]

 Angola
18[citation needed]

 Botswana
18[2]

 Burundi
16[2]
No limit if accompanied by parents[citation needed]

 Cameroon
18
21
18 on the premises, 21 off the premises[citation needed]

 Cape Verde
18[citation needed]

 Central African Republic
18[citation needed]

 Comoros
None[citation needed]

 Egypt
21[2]

 Equatorial Guinea
18[citation needed]

 Eritrea
18[2]

 Ethiopia
18[2]

 Gabon
18[2]

 Gambia
18[2]

 Ghana
18[3]

 Guinea-Bissau
None[2]

 Kenya
18[2]

 Lesotho
18[2]

 Libya
Illegal[2]

 Malawi
18[2]

 Mauritius
18[2]

 Morocco
18[citation needed]
Forbidden for Muslims[2]

 Mozambique
18[2]

 Namibia
18[2]

 Niger
18[2]

 Nigeria
18[citation needed]

 Republic of the Congo
18[citation needed]

 Rwanda
18[2]

 Senegal
18[citation needed]

 Seychelles
18[2]

 Somalia
Illegal[4]

 South Africa
18
The parent, adult guardian of a minor or a person responsible for administering a religious sacrament, may on occasion supply to that minor a moderate quantity of liquor to be consumed by the minor in the presence and under the supervision of that parent, guardian or other person.[5]

 South Sudan
18[6]

 Sudan
Illegal[7]

 Swaziland
18[2]

 Tanzania
18[8]

 Togo
None[2]

 Tunisia
18[citation needed]

 Uganda
18[2]

 Western Sahara
16[citation needed]

 Zambia
18[2]

 Zimbabwe
18[2]

text: Americas[edit]

text:
Country/region
De jure
Notes

Drinking age
Purchase age

 Anguilla
16[citation needed]

 Antigua and Barbuda
16[9]
The sale and distribution of alcohol to a person under 16 years of age is illegal.

 Argentina
18[10]

 Bahamas
18[2]

 Barbados
18[11]
Those aged 10–17 are allowed to consume alcohol provided they are with a parent or guardian.

 Belize
18[12]
Drinking age is rarely enforced. IDs are almost never requested.

 Bermuda
18[13]

 Bolivia
18[2]

 Brazil
18[2]

 British Virgin Islands
16[12]
It is illegal to sell or to supply alcohol to anyone under the age of 16.

 Canada
18[14][15][16]
In Alberta, Manitoba and Quebec, the legal drinking age is 18.

19[14][15][16]
In Ontario, Saskatchewan, British Columbia, Newfoundland and Labrador, Nova Scotia, New Brunswick, Prince Edward Island, Northwest Territories, Yukon, and Nunavut, the legal drinking age is 19.

 Cayman Islands
18[17]

 Chile
18[2]
The minimum age is 18 to enter an enclosure that sells alcoholic beverages. Selling alcohol to a minor may incur a fine. One must provide identification upon request. Residents of Chile over the age of 18 must carry their Chilean identification card issued by the Civil Registry and Identification Service at all times.[18]

 Colombia
18[2]

 Costa Rica
18[2]

 Cuba
16[2]

 Dominican Republic
18[19]

 Ecuador
18[2]

 El Salvador
18[2]

 Falkland Islands
18[citation needed]

 Grenada
16[citation needed]

 Guatemala
18[2]

 Guyana
18[2]
Except 16 for wine or malt liquor to be consumed with a meal

 Haiti
None[2]

 Honduras
18[2]

 Jamaica
None[citation needed]
18[citation needed]
Minors can drink if accompanied by parent or legal guardian as well as someone with permission from their parent or legal guardian.[citation needed]

 Mexico
18[2]
A person must be eighteen years or over to legally purchase and consume alcoholic beverages in Mexico. The drinking age however isn't strictly enforced, and IDs are barely requested.[citation needed]

 Nicaragua
18[2]

 Panama
18[2]

 Paraguay
20[20]

According to Art. 1° of the law to "ban on the sale of alcoholic beverages to minors", it is illegal to serve or sell alcohol or to allow the consumption by minors under 20 years of age.
Furthermore, under Art 2° all public establishments selling alcohol must display a clearly legible notice in the sales area with the following text: "ESTA PROHIBIDA LA VENTA DE BEBIDAS ALCOHÓLICAS A MENORES DE VEINTE AÑOS DE EDAD" (It is illegal (prohibited) to sell alcoholic beverages to minors under 20 years of age)

 Peru
18[2]

 Puerto Rico
18
The minimum age for the selling of any alcohol beverage is 18. Although a valid Puerto Rico license ID or passport is required as proof of age to buyers who look under the age of 18, it is generally not a common practice to ask for ID to enter a venue that sells alcohol or to sell you alcohol at other establishments. This law can be more enforced in some tourist areas and on foreigners visiting the island by some more exclusive hotels, bars, and upscale clubs. A few of the more exclusive venues in the tourist areas may have their own entrance rules regarding age including not allowing anyone under the age of 25 or 23 to enter and consume alcohol or change this depending on specific nights/events and restricted by gender/sex (i.e. women over 18 allowed to enter but only men over 21 on that same night).[citation needed]

 Trinidad and Tobago
18[2]

 Turks and Caicos Islands
18[citation needed]

 United States
(50 states and integral territories)
Varies by jurisdiction[2]
21[2]
The National Minimum Drinking Age Act of 1984 withholds revenue from states that allow the purchase of alcohol by anyone under the age of twenty-one. Prior to the effective date of that Act, the drinking age varied from state to state. Some states do not allow those under the legal drinking age to be present in liquor stores or in bars (usually, the difference between a bar and a restaurant is that food is served only in the latter). Contrary to popular belief, since the act went into law, only a few states prohibit minors and young adults from consuming alcohol in private settings. As of January 1, 2010, fifteen states and the District of Columbia ban underage consumption outright, seventeen states do not ban underage consumption, and the remaining eighteen states have family member or location exceptions to their underage consumption laws.
Federal law explicitly provides for religious exceptions. As of 2005, thirty-one states have family member or location exceptions to their underage possession laws. However, non-alcoholic beer in many (but not all) states, such as Idaho, Texas, and Maryland, is considered legal for those under the age of twenty-one.[21]
By a judge's ruling, South Carolina appears to allow the possession and consumption of alcohol by adults eighteen to twenty years of age, but a circuit court judge has said otherwise.[22]
The states of Washington and Wisconsin allows the consumption of alcohol in the presence of parents.
Some U.S. states have legislation that make providing to and possession of alcohol by persons under twenty-one a gross misdemeanor with a potential penalty of a $5,000 fine or up to year in jail.[23]
See also: Minor in Possession and List of alcohol laws of the United States

 United States Virgin Islands
18[24]

 Uruguay
18[2]

 Venezuela
18[2]

text: Asia[edit]

text:
Country/region
De jure
Notes

Drinking age
Purchase age

 Afghanistan
Illegal[25]

 Bangladesh
Illegal for Muslims[26]
Alcohol will be sold to foreigners in certain locations, albeit clandestinely.

 Bhutan
18[27]

 Brunei
17 with restrictions, unless Muslim[2]
Non-Muslims over 17 years of age are allowed to import alcohol not to exceed maximum total volume 2 liters of liquor and 12 cans of beer at 330 ml for personal use, once in 48 hours. This alcohol must be “stored and consumed at the place of residence of the importer” and is “not to be given, transferred or sold to another person.”.[2]

 Cambodia
None[28]

 China
18[2]
Introduced in January 2006.[29] Weakly enforced to not enforced.

 Hong Kong
18[30]
The regulation is only applicable to restaurants, bars and clubs, where a liquor license is required. Private drinking is also not regulated.

 India
18–25 (varies between states)[2]

Main article: Alcohol laws of India
Consumption of alcohol is prohibited in the states of Bihar, Gujarat and Nagaland.[31]

 Indonesia
21[32]

 Iran
Illegal [2]
There is a ban on alcohol, but religious minorities may purchase small amounts from shops owned by the same religious minority.[33]

 Iraq
18[34]

 Israel
None
18[2]
Israel law prohibits selling or serving alcohol to minors, but it does not prohibit minors to drink, although the police may confiscate alcoholic drinks consumed by minors in public.[citation needed]

 Japan
20[2]

 Jordan
18[35]

 Kazakhstan
21[36]

 Kuwait
Illegal[37]

 Kyrgyzstan
18[2]

 Lebanon
18[2]
Often unenforced and according to a global school health study, 40% of minors over 13 drink alcohol and up to 25% buy it from stores.[38]

 Macau
None[citation needed]

 Malaysia
21
Increased to 21 from 18 on 1 December 2017[39]

 Maldives
Illegal except for tourists, 18[citation needed]
Sale of alcohol is limited to tourist resorts. It is illegal to sell alcohol to local Maldivians[40]

 Mongolia
18[41]

 Myanmar
None
18[42]

   Nepal
18
The legal age for consumption of alcohol in Nepal is 18. However, there are exceptions to underage consumption for purposes of religious ceremonies.[citation needed]

 North Korea
18[43]

 Oman
21
Residents need personal liquor licenses to consume alcohol in their private residences.[44]

 Pakistan
Illegal [2]
Non-Muslim citizens may possess alcohol to be used in accordance with religious ceremonies[2]

 Palestinian Authority
16[citation needed]
Legal in most cities

 Philippines
18[45]

 Qatar
19[citation needed]
Muslims are allowed to purchase alcohol, but generally not allowed to consume. Non Muslims are allowed to purchase, and consume alcohol. The only legal distributor of alcohol in the country is the Qatar Distribution Company located in Doha.[citation needed]

 Saudi Arabia
Illegal
Drinking or possessing alcohol is illegal in the Kingdom of Saudi Arabia. Persons who drink or possess alcohol are subject to arrest and trial. Punishments range from heavy fines, lengthy prison terms and whippings.[citation needed]

 Singapore
None (Private places, sometimes with permission from parents/guardian)
18 (Public places e.g. bars and restaurants)
18[2]

Main Legislation

Drinking alcohol is strictly forbidden in public places in reaction to 2013 Little India riot, after the Committee of Inquiry accepts the recommendations on 7 July 2014.
For convenience stores, those who pretend to be 18 years and above in a "Challenge 18" scheme will be downgraded to "Challenge 21" scheme, and after which the licences will be revoked once they pretend to be 18 years and above if it is on "Challenge 21".
It is illegal to purchase alcohol in Singapore or consume in a nightclub/allow entry to the nightclub under 18. Home and private drinking of alcohol is allowed, although the safest age could be 6. Parents can try a sip of alcohol at any age.[citation needed]

 South Korea
None
19[citation needed]
The age limit for alcohol is after January 1 of the year one's age turns to 19.[citation needed]

 Sri Lanka
21[2]

 Syria
18[citation needed]

 Taiwan
18[46]

It is illegal for anyone under the age of 18 to consume alcohol.[47]
Parents, guardians, and others taking care of people under 18 shall prohibit underage drinking,[48] or risk administrative fines of 10000 to 50000 new Taiwan dollars when the situations are serious.[49]
One shall not supply alcohol to anyone under the age of 18.[50] A violator shall be administratively fined 3000 to 15000 New Taiwan Dollars.[51]

 Tajikistan
18[2]

 Thailand
20[52]
The Alcoholic Beverage Control Act of 2008 increased the drinking age in Thailand from 18 to 20, private drinking is not regulated in private locations.[52][53]

 Turkmenistan
18[2]

 United Arab Emirates
18–21 (varies between states).[54]
Expatriate non-Muslim residents may request a liquor permit to purchase alcoholic beverages, but it is illegal for such holders to provide drinks to others.[55]
The legal age for drinking alcohol is 18 in Abu Dhabi (although a Ministry of Tourism by-law allows hotels to serve alcohol only to those over 21), and 21 in Dubai and the Northern Emirates (except Sharjah, where drinking alcohol is illegal).[54]
It is a punishable offence to drink, or to be under the influence of alcohol, in public.[54]

 Uzbekistan
None
20[2]

 Vietnam
None[citation needed]

 Yemen
Illegal[citation needed]
Exception is in Aden Region where it's legal for 21 and up[citation needed]

text: Europe[edit]

text:
Country/region
De jure
Notes

Drinking age
Purchase age

 Albania
18[2]

 Armenia
None
18
There are no laws mandating alcohol vendors to ID potential underage drinkers. ID checks are very rarely, if ever, carried out.[citation needed]

 Austria
16
 Burgenland,  Lower Austria and  Vienna[56]

16 for beer and wine
18 for distilled beverages
 Carinthia,  Upper Austria,  Salzburg,  Styria,  Tyrol and  Vorarlberg[56]
Carinthia also requires adolescents to maintain a blood alcohol level below 0.05%.

 Azerbaijan
18[2]

 Belarus
18[2]

 Belgium
None
16 for beer and wine
18 for spirits[57]
Since 10 January 2010, it is illegal to "sell, serve, or offer" any form of distilled alcohol to those under the age of 18 or any alcoholic drink to those under 16. So fermented drinks like beer or wine are permitted above 16.[57] Previously, it was illegal to sell alcoholic drinks to under-16s, but accompanying adults could buy drinks for them.

 Bosnia and Herzegovina
None
18[58]

 Bulgaria
18[2]

 Croatia
18[2]

 Cyprus
17[59]

 Czech Republic
None
18[60]
It is illegal to provide alcohol to minors[61] (punishable by fine or up to 1[62] or 2[63] year(s) imprisonment). Consumption itself is not prohibited by law.[64]

 Denmark
None
16 to buy alcohol <16.5% ABV
18 to buy alcohol ≥16.5% ABV
18 to be served in restaurants, bars, discos etc.[2]
While there is no age requirement for drinking alcohol in Denmark, there are laws that prevent minors from buying alcohol:

In order to buy alcohol above 1.2% and below 16.5% ABV in stores, one must be 16 years of age.
In order to buy alcohol above 16.5% ABV in stores, one must be 18 years of age.[65]
To be served alcoholic drinks in bars, discos, clubs, restaurants and any establishment serving alcoholic beverages one must be 18 years of age.

By tradition, youths are privately allowed to drink alcohol after their confirmation.[66] If a shop or bar fails to ask for an ID card and is identified having sold alcohol to an underage, it is subject to fine. A national ID card, obtained in the local town hall, can serve as age verification.[67] This card is rarely used though since a passport or drivers license is more commonly used.[68]
Both the legal drinking and purchasing age in the Faroe Islands is 18.[citation needed]

 Estonia
18[69]

 Finland
18 for possession and purchase of 1.2–22% ABV
20 for possession and purchase of 23–80% ABV
18 for all in bars, clubs and restaurants[70]
All major grocery chains have implemented a policy to ask for ID if the customer looks under 30.[71] Stores may refuse to sell alcohol if the customer is accompanied by a minor, or if proxy purchasing is suspected. Purchasing alcohol on behalf of a minor is a criminal offence.[70][72]
Police may search minors in public places and confiscate or destroy any alcoholic beverages in their possession. Incidents are reported to the legal guardian and social authorities, who may intervene with child welfare procedures. In addition, those aged 15 or above are subject to a fine.[73]
In private, offering alcohol to a minor is considered a criminal offence if it results in drunkenness and the act can be deemed reprehensible as a whole, considering the minor's age, degree of maturity and other circumstances.[70]

 France
None
18
France has no explicitly stated consumption age,[74] but selling alcohol to a minor (under 18) is illegal[75] and can be fined 7500 euros.[74] This age was raised from 16 to 18 in 2009.[76][77]

 Georgia
None
16[citation needed]

 Germany
None (on private residence)
16 (in public) (14 when accompanied by a custodial person) for beer and wine
18 for spirits and aliments containing spirits above negligible amount[78]

16 for beer and wine
18 for spirits and aliments containing spirits above negligible amounts[78]

See also: Alcohol laws in Germany

 Gibraltar
None[79]
16/18
It is illegal to sell alcoholic drinks to anyone under the age of 18.
The minimum age to be served in licensed premises is 16 if:[79]

The alcoholic beverage is beer, wine or cider below 15% ABV, or
The alcoholic beverage is served in a bottle, or a pre-packaged container below 5.5% ABV.

 Greece
None
18[80]
In 2008, the consumption of alcoholic beverages was prohibited for minors in public. However, the law does not apply to private events or private premises.

 Hungary
18[2]

 Iceland
None
20[81]
Possession or consumption of alcohol by minors is not an offence, but supplying them with alcohol is. However, law allows alcohol possessed by a minor to be confiscated.

 Ireland
None (on private residence with permission from parents or guardians) [82]
18[82]
It is illegal for minors to buy alcohol or for a third party to attempt to buy it for minors. It is illegal to purchase alcohol for anybody under the age of consent without permission from their guardians.[83]

 Italy
None
18[84]
In 2012 the then Health Minister Renato Balduzzi proposed to raise the age to 18.[85] Selling alcohol to those under the age of 18 in shops carries a fine between €250 and €1000. Serving alcoholic beverages to those under the age of 16 is a criminal offense and is punished with prison up to one year, if the individual is 16 or 17 it will be treated as an offense that is fined between €250 and €1000 (Legge n. 189/2013).

 Kosovo
None

 Latvia
None
18[86]

 Liechtenstein
16 for wine, beer and cider
18 for spirits and spirit-based beverages. e.g. alcopops
Wine, beer and ciders as well as some other party drinks sometimes without spirits may be purchased by the age of 16. Spirits as well as alcopops may be sold only to people at least 18.[87]

 Lithuania
18[88]
Minors under the age of 18 are prohibited from consuming alcoholic beverages or from having them. From 1st January 2018 the legal drinking age will increase from 18 to 20.[89]

 Luxembourg
None
16[90]

 Macedonia
18 (16 for beer)[91][unreliable source?]
Must show an ID card upon request. In certain smaller places, such as family-owned convenience stores and street kiosks, there is little to no enforcement on how old or young somebody purchases alcohol. There is little to no enforcement for drinking privately, but drinking in bars may require an ID.[citation needed]

 Malta
17[92]
Must provide identification upon request.

 Moldova
None
16[93]
It is illegal to sell alcohol to anyone under the age of 16. There is no consumption age.

 Montenegro
None
18[citation needed]

 Netherlands
18
The legal age for purchasing and consumption of alcoholic beverages was raised from 16 to 18 on 1 January 2014. Alcohol is commonly available upon parental permission. Selling alcoholic beverages to people under 18 is illegal, although giving it away in private is not.[citation needed]

 Norway
None[94]
18 (<22%)
20 (≥22% ABV)[2]
Selling alcohol to or buying alcohol for minors is illegal. Minors are defined as under 18 for beer and wine, under 20 for drinks that contain 22% ABV or more. Minors who buy alcohol are not held criminally responsible; instead, the crime lies with those who sold it or obtained it for them.
Alcohol with more than 60% ABV is generally not sold in Norway, although exceptions may be made by the government for specific products.[95]
Alcohol possessed by minors may be confiscated as evidence. Drinking in public is prohibited, though this is rarely enforced in recreational areas.[96]

 Poland
None
18[97]
Article 15 of The Act on Upbringing in Sobriety and Counteracting Alcoholism[98] clearly states that buyers or persons being served must be at least 18 and prove it with ID if they look like they may not be at least that age. There is no mention of consumption age in this or any other act in Poland. Drinking on streets, town squares, and in parks is illegal regardless of age.

 Portugal
None[citation needed]
18[99]

 Romania
None
18[100]
According to law 61/1991 updated in 2008, paragraphs 21-25, it is illegal to serve or sell alcohol to minors.

 Russia
None
18[101]
There is no law or regulation in Russia that prohibits minors from consuming alcohol, but selling alcohol to minors is prohibited by federal and additional regional laws.

 Serbia
18[102]

 Slovakia
18[103]

 Slovenia
None
18[104]
There is no law regulating the possession and consumption, but it is illegal to sell or offer alcohol of any kind to minors.

 Spain
18
Asturias was the last autonomous community in Spain where the drinking age was increased to 18 (previously 16) on 1 May 2015.[105]

 Sweden

None

None (less than 2.25% ABV)
18 (bars and restaurants),
18 (2.25%–3.5% ABV in food shops),
20 (Systembolaget shops[106]),

See also: Alcohol in Sweden
Many clubs choose to have higher age limits than 18, commonly 20 or 23. It is legal to drink below 18, but it is illegal to sell, lend or give alcohol to someone under that age and the police can seize alcohol from them, apart from being served alcohol supervised in private "in moderation". It is legal to serve an underage person alcohol in a private place.[107] The reason for lower limit in bars than in Systembolaget shops is that bartenders have a legal responsibility for how drunk a guest gets.

  Switzerland
None
(See notes)
16 for fermented alcoholic drinks (with less than 15% ABV and natural wines with less than 18% ABV);[108]
18 for spirits [109]
Whoever offers or supplies alcoholic beverages to a child under the age of 16 years in an amount which is harmful to one's health is punished with imprisonment up to 3 years or a fine.[110] Whoever sells or supplies spirits to a person under the age of 18 years is punished with a fine up to 10.000 CHF.[111]

18
The canton Ticino prohibits selling and consumption of any type of alcohol by minors under the age of 18. Some shops and supermarkets may not sell alcohol to minors under the age of 18.[112]

 Turkey
18[2]

See also: Alcohol laws of Turkey

 Ukraine
18[2]

 United Kingdom
18 (on licensed premises)[113]
16 (beer, wine or cider with a meal on licensed premises)[113]
5 (not on licensed premises)[114]
None (under medical supervision, or in an emergency)[114]
18[113]
None (liqueur-confectionery)[115]
Legislation in  England and  Wales:

It is illegal to sell, serve, offer or consume alcoholic beverages on licensed premises under the age of 18, other than the following two exceptions.[113]
Minors aged 16 or 17 may consume wine, beer or cider on licensed premises when ordered with a meal, and accompanied by an adult.[113]
It is legal to sell liqueur confectionery to someone of any age.[115]
It is illegal to permit minors under the age of 5 to consume alcoholic beverages unless under medical supervision or in an emergency.[114]
Persons over 17 are entitled to their own duty free allowance, which includes alcohol. [116]

18 (in public without a meal or adult supervision)
16 (beer, wine or cider on licensed premises with meal)
5 (on private premises)[117]
18
16 (beer, wine, cider or perry with a meal on licensed premises)
None (liqueur-confectionery)[115]
Legislation in  Scotland:

It is illegal to sell, serve, offer or consume alcoholic beverages in public under the age of 18.[118]
Minors aged 16 or 17 may consume wine, beer or cider on licensed premises when ordered with a meal.[118]
It is legal to sell liqueur confectionery to someone of any age.[115]
Persons over 17 are entitled to their own duty free allowance, which includes alcohol. [116]

18
Legislation in Northern Ireland:
It is illegal to sell, serve, offer or consume alcoholic beverages in public under the age of 18.[citation needed]

Challenge 21 and Challenge 25 (applies to all of the  United Kingdom)
Under the BBPA's Challenge 21 and Challenge 25 schemes, customers attempting to buy alcoholic beverages are asked to prove their age if in the retailer's opinion they look under 21[119] (or optionally 25) even though the law states they must be a minimum of 18. Many supermarket and off-licence chains display Challenge 21 (or Challenge 25) notices stating that they will not serve persons who look under 21 (or 25) without ID.

text: Oceania[edit]

text:
Country/region
De jure
Notes

Drinking age
Purchase age

 American Samoa
21[120]

 Australia
18[2][121]

Main article: Alcohol laws of Australia
Varies by state. Some states restrict possession and consumption to over 18, all states restrict purchasing to over 18. In some states, minors may consume alcohol in a private residence with parental permission.[122]

 Fiji
18[123]
The drinking age was 21 from 2006 to 2009 but was lowered to 18 in 2009.[123]

 Guam
21[124]

 Micronesia, Federated States of
21

 New Zealand
None
18[125]
Minimum age applies for beverages with 1.15% ABV or over; no restrictions on beverages less than 1.15% ABV.[126]
Persons under 18 may drink outside private residences or private functions if accompanied by their parent or legal guardian. Alcohol may be supplied to minors only by, or with express consent from, their parent or legal guardian.[127]

 Northern Mariana Islands
21[citation needed]

 Palau
21[2]

 Papua New Guinea
18[2]

 Samoa
21[2]

 Solomon Islands
21[2]

 Tokelau
18[128]

 Tonga
21[2]

 Vanuatu
18[2]